北京房山区心房颤动脑卒中高危老年人群抗凝治疗调查  

Analysis of anticoagulant therapy in high-risk population of stroke with atrial fibrillation in Fangshan District,Beijing

作　　者：马云峰 孟庆伟[1] 韩文芹[1] 伊丽瑾 王朝斌 Ma Yunfeng;Meng Qingwei;Han Wenqin;Yi Lijin;Wang Chaobin(Department of Neurology,Fangshan District,Liangxiang Hospital,Beijing 102401,China)

机构地区：[1]北京市房山区良乡医院神经内科,北京102401

出　　处：《脑与神经疾病杂志》2024年第5期297-301,共5页Journal of Brain and Nervous Diseases

基　　金：2020年首都卫生发展科研专项基金资助(2020-3-7072)。

摘　　要：目的通过调查北京市房山区心房颤动(AF)脑卒中高危老年人群的抗凝治疗现状及原因分析,为AF脑卒中高危老年人群规范化的抗凝治疗提供临床依据。方法通过社区体检筛选AF脑卒中65岁及以上高危人群,调查问卷发现AF脑卒中高危人群的抗凝治疗现状:结果(1)筛选出符合纳入标准且不存在排除标准AF患者共703例,其中299例(42.5%)患者接受了抗凝治疗,华法林145例,利伐沙班86例,达比加群68例。65~74岁、75~90岁、>90岁3个不同年龄段年龄越大抗凝比例越低,差异有统计学意义(P<0.05);(2)在703例AF患者中267例患脑梗死,其中抗凝109例(40.8%)。无脑梗死患者436例,抗凝为191例(43.8%)。脑梗死组与无脑梗死组抗凝比例差异无统计学意义,P=0.48;(3)AF脑卒中高危人群未抗凝原因有:医生未明确告知需要抗凝(48.5%);患者不知道抗凝的重要性(30.9%);医生明确告知需要抗凝,但患者担心出血(24.8%);虽医生告知需要抗凝,因华法林需要定期检测凝血,医疗条件不允许(21.3%);口服新型抗凝药价格昂贵,负担不起费用(7.9%);(4)年龄、脑梗死、高血压、糖尿病及冠心病作为AF脑卒中高危人群抗凝治疗的影响因素比较差异有统计学意义(P<0.05):结论(1)年龄、脑梗死、高血压、糖尿病及冠心病是AF脑卒中高危人群抗凝治疗的影响因素,年龄越大抗凝比例越低,已经发生脑梗死的患者在诊治过程中并未因心源性脑栓塞抗凝比例增加;(2)AF脑卒中高危人群未抗凝原因中医生未明确告知需要抗凝占比最大,所以需要临床一线医生提高规范诊疗意识,应抗凝则抗,降低AF心源性脑卒中的发生风险。Objective To investigate the current situation of anticoagulant therapy and to analyse the reasons for the current situation of anticoagulant therapy among the high-risk population of stroke in elderly people caused by atrial fibrillation(AF)in Fangshan District,Beijing,so as to promote standardized anticoagulant therapy in highrisk population of stroke caused by AF.Methods Community physical examination was used to screen the high-risk population of stroke in aged 65 years and above caused by AF,and the anti-coagulation status of high-risk population of stroke caused by AF was found by questionnaires.Results A total of 703 AF patients who met the inclusion criteria and did not have exclusion criteria were screened out.Among them,299(42.5%)patients received anticoagulant therapy,The higher the age,the lower the proportion of anti-coagulation in the three different age group(65-74 years old,75-90 years old and above 90 years old),there was a statistical difference(P<0.05);②Among 703 patients with AF,267 cases suffered from cerebral infarction,of which 109(40.8%)cases received anti-coagulation therapy.There were 436 patients without cerebral infarction and 191(43.8%)with anti-coagulation.There was no statistical significance in the anti-coagulation ratio between cerebral infarction group and non-cerebral infarction group(P=0.48);③The reasons why the high-risk population of stroke caused by AF did not receive anticoagulant therapy were Doctors did not clearly inform the need for anti-coagulation(48.5%).Patients did not know the importance of anticoagulation(30.9%).Doctors told patients that anti-coagulation was needed,but patients were concerned about bleeding(24.8%).Although the doctor told the need for anti-coagulation,warfarin requires regular blood clotting tests,which was inconvenient(21.3%);New oral anticoagulants are expensive and unaffordable(7.9%):@Age,cerebral infarction,hypertension,diabetes and coronary heart disease were statistically significant influencing factors for anti-coagulant therapy in hig

关 键 词：心房颤动 脑卒中 抗凝治疗 

分 类 号：R743.32[医药卫生—神经病学与精神病学]